Jan 05 2014

The 2 Shoes Plateau!

Published by hopalong at 6:13 am under Uncategorized

Hi all

Hope Santa brought some new tendons!

Been a month+ in 2 shoes, so thought I would update on the slow slow progress that is the Conservative Approach. So that you guys and gals who rightly decided to go WB/rehab early can see what you are missing! After the discernible milestones of PWB, FWB et al, the achievements in 2 shoes are measured in millimetres!

Quick recap. Non Op, ultra conservative route: 9 weeks casts, then boot for 5weeks. Currently at week 20, or 5 months! So proof if needed that Norm is right! Lots of casting; slow to introduce rehab = “locked” ankle/tendon. So only just now beginning to walk “normally’ albeit very slowly! The problem is as much in the front of the ankle as it is in the tendon and stiff calf. All need to be warmed up/deeply massaged in order to make the new hallowed ground of “knee to the wall”. However achieved that on last physio session, so the New Year is looking bright! (the ankle has unlocked by about a cm a week!) During the holidays did a fair amount of walking - esp compared to the earlier 4 months. Found that all very tiring and have found compression socks really useful (wish I had known about them before the injury!).

In terms of rehab, get physio once a week, which is mainly all about unlocking the ankle at this stage. Swim for my sanity and to loosen off. Have started on the breaststroke kick. Seems Ok and gives a good ROM in the water. Heel raises only in the water at this stage. and lots of walking. Evenings do a self massage and find both calves really tight.

Concerns now are on the OTHER tendon and how best to protect it, as its had a hammering over the last 5 months and as one of the articles on here points out  once one has gone the other is more likely to go. Good leg calf is tight aswell, and got physio working on that. PT suspects tendenosis and rest appears to be the answer!

In retrospect, suspect that there have been a number of contributory causes to the weakening of both achilles over the years. 20 odd years in boots, with laces tied off around the tendon; barefoot walking on hard floors in the house; not stretching tendons off post and prior to exercise; and running up and down mountains probably hasnt helped!

Then more recent contributory causes:

Been living in Merrills Eagle boots for the last 2 years. Always made my lower legs ache, but I tended to ignore and work thru! Mistake! The Eagles have a pretty flat sole. Then 3 weeks prior to the injury was on a diving exped with slightly too large flippers. Then  there was missing a step and subsequent hyperextension during a run!

Have gone for a pair of ASICS Gel NIMBUS (the max for cushioning) as my walking shoe (with heel raise) and wear a pair of mocossans type with insole + a heel raise in the house.

So that is the picture from the slow windy road! I read your comments on jogging with jealousy!

Any thoughts on best footware and on protecting the other tendon most welcome.

cheers Hoppy (although more like slightly limpy now!)

7 Responses to “The 2 Shoes Plateau!”

  1. normofthenorthon 05 Jan 2014 at 3:05 pm

    Glad you’re coming along. Frustrating that “conservative” means two QUITE DIFFERENT things in ATR-speak: (1) It means non-operative, and (2) It (still!) means SLOW. Frustrating because COMBINING the two is BAD, and not at all “conservative”min the THIRD sense, i.e. playing it safe. (Sorry for the shouting.) Great that you skipped the rerupture (15-20% risk that way).

    Immobilization is unnatural and Bad, except when necessary. Good shoes are Good. But “protecting” body parts can be Bad! Your/our risk of an ATR on the other side is way elevated compared with your neighbors, but still unlikely, maybe 1-2% lifetime. Even if it’s 10%, it might not be worth giving up beloved sports etc.

    The latest evidence on “protecting” is shocking: A fair % of chronic backaches seem to be caused by it! People who’ve had a backache (most of us) and don’t want another (”) walk and bend and twist unnaturally, to keep their backs safe. But many of those unnatural postures put MORE strain on our backs, and cause chronic backaches!!
    There’s a great explanation on this AND on why you should NOT get an MRI of your back(!) in last April 8th’s episode of “The Health Report”, radio, podcast, & transcript from Australia’s ABC aka RN. It’s the best science show I’ve ever heard, and that episode is gold if you know anybody with backaches.

  2. normofthenorthon 05 Jan 2014 at 3:09 pm

    And BTW, the latest evidence on pre-sports stretching is that (1) it does NOT decrease injuries and (2) it DECREASES sports performance! Stretching as a session, or after sports, may well be helpful, but not before the big game…

  3. anneon 05 Jan 2014 at 8:45 pm

    Hiya…..

    I think you said it perfectly, progress is measured in millimeters. I am 5.5 months post op. I went non-op the first time around and my first day out of the cast and in the boot I reruptured so I had surgery.

    Then I was 6 weeks in a cast and 5 weeks in a boot. I am sort of happy with being in protective custody all that time because the ball of my foot was and still is weak. The vacocast allowed me to be quite active in the boot so I was pleased.

    I found that I made the most progress within 3 weeks of being in two shoes and now I am barely inching forward. I am still making improvements, but now I have setbacks in which I have to rest or I will not be able to do something at the same level two days in a row.

    Congrats on making it this far. Keep posting your progress.

  4. loumar747on 05 Jan 2014 at 11:43 pm

    Hi hopalong,

    The process does continue to be SLOW but is sooo much better than the first few months it’s hard to complain too much. I’m at 34 weeks and ,finally, finally can walk without a limp unless I start going at too fast a pace. Trying to strengthen the ‘push off’ the front of the foot is indeed difficult. I’m also still waiting to be able to do the heel raise with no support. I, too, am terrified of re-rupturing or of rupturing the good leg but try to push the thoughts well into my subconscious. Haven’t been going to physio for awhile but think it’s time for a return visit.

    Keep up the positive attitude. I haven’t posted for quite awhile and see that, other than Norm, who thankfully is still offering his advice and support to bloggers, most of those who were blogging at the time I ruptured my achilles are no longer posting which means they’ve been successful in their recovery. So - keep the faith - Jogging is just around the corner!

  5. hopalongon 06 Jan 2014 at 9:28 am

    Hi Team Achilles
    Many thanks for the replies and support. Norm as always, appreciate your in depth knowledge. Good to hear I shouldnt be beating myself up about not stretching prior to phys! As for my back - I thought it was OK - now not so sure!!
    Anne - sorry to hear about your rerupture and agree VACO boot was a god send. Also agree that leg (s) need a rest after strenuous days. I think it was you who mentioned in an earlier post that good leg also gets sore. Ditto.
    Lomar747 - Yep, we need to look on the bright side. 2 shoes although slow - is so much better than crutches. The other half doesnt have an extra child to look after any more - well not most of the time!
    As an aside, got the knee thru the wall today at PT. Well not literally, but to the wall and when he moved the foot back by 1 cm, was still able to reach the wall! Yay! An interesting ‘massage” he did was just bending the big toe back. Seemed to stretch something and allowed more ROM. One to try at home!
    Then on leaving the PT, who is incoming but a rerupturer!! So gave him the keys to this site. One more convert!
    Thanks for the positive comments - seem to recall a story about a hare and a tortoise…….!
    Hoppy

  6. kimcon 06 Jan 2014 at 12:30 pm

    Regarding shoes: I’m also wearing an Asics Nimbus for my walking shoe. It was my running shoe for several years, but when the insertional achilles issues arose, I couldn’t wear it any more because I was supinating way too much. Now, after surgery, my foot isn’t locked up and the Nimbus works and feels great. It does not have a hard heel counter and that really helps with the still sensitive heel bone. Like you, I am wearing a moccasin-like shoe in the house. Soft around the heel and tendon feels best.

  7. Hopalongon 07 Jan 2014 at 9:51 am

    Hi KimC
    Great to hear we are wearing the same shoes! Looks like you have been dealing with this for some time, so hopefully you are healing well now.
    I also looked at MBTs (they have a rocker type sole), but thought I was more likely to turn an ankle!
    Cheers Hoppy

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